(1) Field of the Invention
The present invention relates generally to a hand instrument for use during surgical procedures to hold and manipulate a suturing needle, and in particular to an instrument of this type that can be used to move a surgical needle along a curved pathway.
(2) Description of the Prior Art
Surgical procedures normally require suturing or stitching of tissues to close incisions or other cuts. This suturing is performed by pushing a needle through one side of the tissue to be sutured, and grasping the needle tip on the exit side to withdraw the needle. The needle and attached suture can then be drawn through the tissue and the suture tied.
Suturing is a relatively simple procedure when performed on external tissues, since the surgeon can easily manipulate the instruments used to insert and withdraw the needle. Many surgical procedures, however, require suturing of internal tissues or organs, severely limiting the ability of the surgeon to manipulate the needle holder to push the needle through the tissue.
Several instruments are described in the prior art that purport to address this problem. The following patents are representative of prior art suturing instruments:
______________________________________ U.S. Pat. No. Inventor(s) ______________________________________ 5,843,100 Meade 3,139,089 Schwerin 5,556,402 Xu 5,540,705 Meade et al. 3,168,097 Dormia 3,638,654 Akuba 5,224,948 Abe et al. 5,282,806 Haber et al. 5,201,743 Haber et al. 5,707,379 Fleenor et al. ______________________________________
Generally, these instruments are comprised of a handle or holder that has a needle grasping member at its distal end, a means to open and close the needle grasping member, and a manipulation means to rotate the needle grasping member. The handle may be comprised of first and second members with opposed jaws that are designed to open and close the needle grasping member. In some instruments, the needle grasping member is designed to rotate about an axis that is parallel to the longitudinal axis of the handle, while the needle grasping member in other instruments rotates about an axis that is transverse to the longitudinal axis of the handle.
A representative instrument is described in U.S. Pat. No. 5,843,100 to Meade. The Meade instrument comprises a pair of scissor-like arms having distal ends, with a needle grasping member rotatably attached at a pivot point to the distal ends. This needle grasping member is comprised of opposed sections that may be clamped together to grasp the proximal end of a surgical needle at the axis of rotation of the needle grasping member. The needle grasping member is connected to a manipulation means that is used to rotate the needle grasping member, causing the tip of the needle to move along a circular path.
Prior art instruments, particularly instruments in which the needle is to be carried along a pathway with a plane of rotation parallel to the longitudinal axis of the instrument have various defects that limit their usefulness in surgical procedures. Of major concern is the fact that rotation of a needle using an instrument of the type described by Meade causes a clawing or tearing action that can damage the tissues, and also makes insertion of the needle into the tissue difficult.
Additionally, there is a tendency in many instruments for the needle to shift out of alignment when pressure is exerted to insert the needle through tissue. Proper initial alignment of the needle in the instrument under operating conditions also presents a challenge to the surgeon, or assistant. Use of the instrument to pull the needle the rest of the way through the tissue after the needle has been inserted into the tissue can also be difficult.
Another reason needle manipulating instruments have found limited acceptance is the fact that most instruments are designed to hold a needle of only one size. Needles of different sizes are used during surgery, however, necessitating the costly acquisition, and subsequent sterilization, of plural needle manipulating instruments.
The convenience to the surgeon, and the acceptance of these instruments, would be considerably improved if these problems were addressed.